20120809 Ver 1_Application_20120828

STATE OF NORTH CAROLINA
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DEPARTMENT OF TRANSPORTATION '�R,
BEVERLY EAVES PERDUE
GOVERNOR
August 22 2012
Ms Liz Hair
US Army Corp of Engineers
Asheville Regulatory Field Office
151 Patton Avenue Room 208
Asheville N C 28801 5006
EUGENE A CONTI JR
SECRETARY
270809
SUBJECT Bridge #129 Replacement SR 1577 (Pisgah Ridge Circle) Iredell County
Dear Ms Hair
The North Carolina Department of Transportation (NCDOT) requests authorization to replace
Bridge 4129 on SR 1577 (Pisgah Ridge Circle) in Iredell County with double 50 foot corrugated
arched metal pipes The main flow pipe will be 142 x 91 CMPA and will be buried based
upon the existing streambed elevation The 128 x 83 flood flow pipe will be installed at
streambed elevation and will tie into existing stream benches Approximately 15 feet of riprap
will be used at the pipe outlet and 5 feet at the pipe inlet for structure /bank stabilization
Temporary cofferdams /bypass pumping will be used to divert the stream flow around the
construction sites as needed Upon project completion any areas affected by temporary
cofferdams will be restored to pre project conditions
The total scope of the work will impact 70 feet of an unnamed tributary to Snow Creek which is
classified as a WS IV watershed by the Division of Water Quality
The project is not located within '/z mile of any critical watershed area nor is SR 1577 a rural or
urban arterial therefore hazardous spill basins are not required Enclosed is the hazardous spill
basin checklist
This office has conducted a GIS and field survey for the project for historical sites and
threatened /endangered species sites No sites listed on the National Register of Historic Places
are located in the vicinity of the project nor did there appear to be any eligible structures The
federally listed species for Iredell County (USFWS listed date September 22 2010) include the
Dwarf flowered heartleaf (Hexastylis naniora) and the Bog Turtle (Clemmys muhlenbergit)
Post Office Box 47 Shelby North Carolina 28151 0047

Bridge #129 SR 1577 Pisgah Ridge Circle
Page 2
August 22 2012
The Natural Heritage Program records document the nearest dwarf flowered heartleaf location
approximately 18 miles northwest of the proposed project The heartleaf is usually found on dry
to moist ravine slopes (usually north facing and of the oak hickory pine forest type) and in boggy
areas near sprmgheads There is no potential habitat within the proposed project area and no
species were observed National Heritage Program records document the nearest bog turtle
location approximately 6 5 west of the proposed project area Bog turtles are usually found in
bogs marshes and wet pastures There is no suitable habitat located within the project area The
proposed project will have a finding of no effect on the dwarf flowered heartleaf (Hexastylis
naniora) species or bog turtle (Clemmys muhlenbergn)
I have enclosed a pre construction notification for a NW #14 sketches of planned activities and
location maps relative to the project Please advise if mitigation is required Any necessary
mitigation that may be necessary for the construction of the project will be provided in
accordance with the procedures detailed in the U S Army Corp of Engineers letter dated
September 1 2004 from Mr Ken Jolly to Dr Gregory J Thorpe
Project information for the 401 Automated Payment Procedure is as follows
• Work order number 150465 55120005 12B 204911 3300
• TIP # NA
• Project Category $240 00 Fee
If you have any questions or concerns please feel free to contact me at (704) 480 -9044 Thank
you for your time and consideration to this matter
BY
Enclosures
Respectfully yours
M L Holder P E
Division Engineer
Twelfth Division
Trish Beam
Division 12 Environmental Supervisor
Cc David Wainwright DWQ 401 /Transportation Permitting Unit
Alan Johnson DWQ Mooresville Regional Office

Office Use Only
Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Page 1 of 10
PCN Form — Version 1 3 December 10 2008 Version
Pre - Construction Notification PC Form
A Applicant Information
1
Processing
1 a
Type(s) of approval sought from the
Corps
®Section 404 Permit El Section 10 Permit
1 b
Specify Nationwide Permit (NWP) number 14 or General Permit (GP) number
1c
Has the N WP or GP number been verified by the Corps?
❑Yes
® No
1 d
Type(s) of approval sought from the DWQ (check all that apply)
® 401 Water Quality Certification — Regular ❑ Non 404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification
❑ Yes ® No
For the record only for Corps Permit
❑ Yes ® No
1f
Is payment into a mitigation bank or in lieu fee program proposed for mitigation
of impacts? If so attach the acceptance letter from mitigation bank or in lieu
fee program
❑ Yes
® No
1g
Is the project located in any of NC s twenty coastal counties If yes answer 1 h
below
❑ Yes
® No
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2
Project Information
2a
Name of project
Bridge #129 SR 1577 (Pisgah Ridge Circle)
2b
County
Iredell
2c
Nearest municipality / town
Statesville
2d
Subdivision name
NA
2e
NCDOT only T I P or state
project no
NA
3
Owner Information
3a
Name(s) on Recorded Deed
NCDOT Right of Way
3b
Deed Book and Page No
3c
Responsible Party (for LLC i f
applicable)
3d
Street address
3e
City state zip
3f
Telephone no
3g
Fax no
3h
Email address
Page 1 of 10
PCN Form — Version 1 3 December 10 2008 Version

4
Applicant Information (if different from owner)
4a
Applicant is
❑ Agent ❑ Other specify
4b
Name
Mike Holder
4c
Busines s name
(if applicable)
N C Department of Transportation Division 12
4d
Street address
1710 East Marion Street
4e
City state zip
Shelby NC 28151
4f
Telephone no
704 480 9020
4g
Fax no
704 480 5401
4h
Email address
mholder @ncdot gov
5
Agent/Consultant Information (if applicable)
5a
Name
Trish Beam
5b
Business name
(if applicable)
N C Department of Transportation Division 12
5c Street address
1710 East Marion Street
5d
City state zip
Shelby NC 28151
5e
Telephone no
704 480 9044
5f
Fax no
704 480 5401
5g
Email address
pdbeam @ncdot gov
Page 2 of 10
PCN Form — Version 1 3 December 10 2008 Version

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
NA
lb Site coordinates (in decimal degrees)
Latitude 35 92458 Longitude 8098587
(DD DDDDDD) ( DD DDDDDD)
1c Property size
0 10 acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
proposed project
UT to Snow Creek
2b Water Quality Classification of nearest receiving water
WS IV
2c River basin
Yadkin
3 Project Description
3a Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application
Existing timber bridge on paved secondary road Landuse in vicinity of bridge is mostly wooded
3b List the total estimated acreage of all existing wetlands on the property
0
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
100
3d Explain the purpose of the proposed project
To replace a deteriorating timber deck bridge for the safety of the traveling public
3e Describe the overall project in detail including the type of equipment to be used
NCDOT proposes to replace a timber deck bridge with a double 50 foot long CMPA s with a 142 x 91 main flow pipe
and a 128 x 83 flood flow pipe Fifteen feet of riprap will be used at the corners of the culverts for structure stabilization
4 Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Comments Jurisdictional stream determination made by
Division 12 DEO
❑ Yes ® No ❑ Unknown
4b If the Corps made the jurisdictional determination what type
of determination was made?
❑ Preliminary ❑ Final
4c If yes who delineated the jurisdictional areas?
Name (if known)
Agency /Consultant Company
Other
4d If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
5 Project History
5a Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
5b If yes explain in detail according to help file instructions
6 Future Project Plans
6a Is this a phased project?
❑ Yes ® No
6b If yes explain
Page 3 of 10
PCN Form — Version 1 3 December 10 2008 Version

C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
❑ Wetlands ® Streams tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2 Wetland Impacts
If there are wetland impacts proposed on the site then complete this question for each wetland area impacted
2a
2b
2c
2d
2e
2f
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps 404 10
Area of impact
Permanent (P) or
(if known)
DWQ —non 404 other)
(acres)
Temporary T
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g Total wetland impacts
2h Comments
3 Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site then complete this
question for all stream sites impacted
3a
3b
3c
3d
3e
3f
3g
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number
(PER) or
(Corps 404 10
stream
length
Permanent (P) or
intermittent
DWQ — non 404
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ®P ❑ T
Fill from culvert
Ut to Snow Creek
® PER
® Corps
10
50
construction
E:1 INT
®DWQ
S2 ®P ❑ T
Riprap Structure
Stabilization
Ut to Snow Creek
® PER
❑ INT
® Corps
® DWQ
10
20
S3 ❑ PET
Impervious dike
for culvert
Ut to Snow Creek
® PER
E:1 INT
® Corps
®DWQ
10
100
construction
S4 ❑ P ❑ T
❑ PER
❑ Corps
[:11 NT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and tributary impacts
70
31 Comments Permanent Impacts
Page 4 of 10
PCN Form — Version 1 3 December 10 2008 Version

4 Open Water Impacts
If there are proposed impacts to lakes ponds estuaries tributaries sounds the Atlantic Ocean or any other open water of
the U S then individually list all open water impacts below
4a
4b
4c
4d
4e
Open water
Name of waterbody
Zone 1 impact
Zone 2 impact
Permanent (P) or
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
impact
required
Temporary T
B1 ❑P ❑T
F-1 Yes
01 ❑P ❑T
02 ❑P ❑T
B2 ❑ P ❑ T
03 ❑P ❑T
❑ Yes
04 ❑P ❑T
❑ No
4f Total open water impacts
4g Comments
5 Pond or Lake Construction
If pond or lake construction proposed the complete the chart below
5a
5b
5c
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
I Filled
I Excavated
FloodedJ
Filled
I Excavated
Flooded
P1
P2
5f Total
5g Comments
5h Is a dam high hazard permit required?
❑ Yes ❑ No If yes permit ID no
51 Expected pond surface area (acres)
51 Size of pond watershed (acres)
5k Method of construction
6 Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer then complete the chart below If yes then individually list all buffer impacts
below If anv impacts reauire mitigation then you MUST fill out Section D of this form
6a
❑ Neuse ❑ Tar Pamlico ❑ Other
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b 6c 6d 6e 6f 6g
Buffer impact
number—
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Tem ora T
impact
required
B1 ❑P ❑T
F-1 Yes
❑ No
B2 ❑ P ❑ T
❑ Yes
❑ No
B3 ❑P ❑T
❑Yes
❑ No
6h Total buffer impacts
61 Comments
Page 5 of 10
PCN Form — Version 1 3 December 10 2008 Version

D Impact Justification and Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
Disturbance to existing instream floodplain benches to be minimized and the high flow pipe will be installed to tie into these
existing benches
1b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Minimization of impacts by installing appropriate erosion control measures
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State
2a Does the project require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
❑ Yes ® No
2b If yes mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
2c If yes which mitigat ion option will be used for this
project?
❑ Mitigation bank
❑Payment to in lieu fee program
❑ Permittee Responsible Mitigation
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank
3b Credits Purchased (attach receipt and letter)
Type
Quantity
3c Comments
4 Complete if Making a Payment to In lieu Fee Program
4a Approval letter from in lieu fee program is attached
❑ Yes
4b Stream mitigation requested
linear feet
4c If using stream mitigation stream temperature
❑ warm ❑ cool ❑cold
4d Buffer mitigation requested (DWQ only)
square feet
4e Riparian wetland mitigation requested
acres
4f Non riparian wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested
acres
4h Comments Any mitigation necessary shall be provided in accordance with the procedures detailed in the USACE letter
dated September 1 2004 from Mr Ken Jolly to Dr Gregory J Thorpe
5 Complete if Using a Permittee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan provide a description of the proposed mitigation plan
Page 6 of 10
PCN Form — Version 1 3 December 10 2008 Version

6 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ® No
6b If yes then identify the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required
Zone
6c
Reason for impact
6d
Total impact
(square feet)
Multiplier
6e
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1 5
6f Total buffer mitigation required
6g If buffer mitigation is required discuss what type of mitigation is proposed (e g payment to private mitigation bank
permittee responsible riparian buffer restoration payment into an approved in lieu fee fund)
6h Comments
Page 7 of 10
PCN Form — Version 1 3 December 10 2008 Version

E Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
la
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b
If yes then is a diffuse flow plan included? If no explain why
❑ Yes ❑ No
Comments
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
0%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
If this project DOES NOT require a Stormwater Management Plan explain why Complies with NCDOT s individual
NPDES permit NCS000250
2d
If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
❑ Certified Local Government
2e
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3
Certified Local Government Stormwater Review
3a
In which local government s jurisdiction is this project?
NA
❑ Phase II
3b
Which of the following locally implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4
DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a
Which of the following state implemented stormwater management programs apply
❑ ORW
(check all that apply)
❑ Session Law 2006 246
❑ Other
4b
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
5
DWQ 401 Unit Stormwater Review
5a
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1 3 December 10 2008 Version

F Supplementary Information
1 Environmental Documentation (DWQ Requirement)
la Does the project involve an expenditure of public (federal /state /local) funds or the
® Yes ❑ No
use of public (federal /state) land?
lb If you answered yes to the above does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c if you answered yes to the above has the document review been finalized by the
State Clearing House? (If so attach a copy of the NEPA or SEPA final approval
❑ Yes ❑ No
letter )
Comments
2 Violations (DWQ Requirement)
2a Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500) Isolated
Wetland Rules (15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 26 0200)?
2b Is this an after the fact permit application?
❑ Yes ® No
2c If you answered yes to one or both of the above questions provide an explanation of the violation(s)
3 Cumulative Impacts (DWQ Requirement)
3a Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes ® No
additional development which could impact nearby downstream water quality?
3b If you answered yes to the above submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy If you answered no provide a short narrative description
The project is classified as a minimum criteria checklist project which has low potential for cumulative /indirect impacts and
will not result in additional development which could impact water quality
4 Sewage Disposal (DWQ Requirement)
4a Clearly detail the ultimate treatment methods and disposition (non discharge or discharge) of wastewater generated from
the proposed project or available capacity of the subject facility
Page 9 of 10
PCN Form — Version 1 3 December 10 2008 Version

5 Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
E:1 Raleigh
5c if yes ind icate the USFWS Field Office you have contacted
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program database
6 Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
No salt marshes oyster reefs or seagrass beds in the vicinity of the project
7 Historic or Prehistoric Cultural Resources (Corps Requirement)
7a Will this project occur in or near an area that the state federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ® No
status (e g National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
The National Register of Historic Places were reviewed for historic sites in the vicinity of the project however the bridge
replacement project occur within a previously impacted area (NC DOT Right of Way)
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA designated 100 year floodplain?
❑ Yes ® No
8b If yes explain how project meets FEMA requirements
8c What source(s) did you use to make the floodplain determination? FEMA FIRM panal number 3710470800E
M L �1 �r
,�oCL. '�
g a� - 0-
Applicant/Agents Printed Name
Date
Applicant/Agents Signature
(Agents signature is valid only if an authorization letter from the applicant
is provided )
Page 10 of 10
PCN Form — Version 1 3 December 10 2008 Version

Vicinity Map
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NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division 19 County Tredell Project ID 1213204911
River Basin Yadkin Bridge No 129
Route SR 1577, Pisgah Ridge Circle Stream UT to Snow Creek
Water Quality Criteria
Yes No
Stream Crossing Blue Line On USGS w -
ORW F 1V
WSI F
WS II,III OR IV, Crossing Within 0 5mi of W S Critical Area f
Roadway Critena
Route Designation-
Arterial Urban
Arterial Rural
Additional Site Information
Is a Hazardous Spill Basin Required?
rdm -1if
r ry
r
Yes No
r- r
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997)